Cardiotoxicity Associated With Intentional Ziprasidone And Bupropion Overdose

Biswas, Abhik K.; Zabrocki, Luke; Mayes, Kendra L.; Morris-Kukoski, Cynthia L.

doi:10.1081/clt-120018276

Cited by 22 publications

(12 citation statements)

References 12 publications

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“…There were only two cases of TdP in the antipsychotic drug group, both associated with ziprasidone overdose. This is consistent with previous reports that ziprasidone appears to prolong QTc to a greater extent than other antipsychotics, including quetiapine, risperidone, olanzapine and haloperidol [38][39][40][41].…”

Section: Discussionsupporting

confidence: 82%

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Al-Abri

Woodburn

Olson

et al. 2015

Am J Cardiovasc Drugs

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Key PointsThe most commonly involved therapeutic classes of drugs associated with ventricular fibrillation and/or tachycardia (VT/VF) were antidepressants (25 %) and stimulants (25 %).The drugs most commonly associated with torsade de pointes (TdP) were antidepressants (25 %) and methadone (25 %).Drug exposures with the greatest risk of death in association with VT/VF were antidepressant exposure [odds ratio (OR) 1.71] and antiarrhythmic exposure (OR 1.75), but neither association was statistically significant.

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Section: Discussionsupporting

confidence: 82%

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Al-Abri

Woodburn

Olson

et al. 2015

Am J Cardiovasc Drugs

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“…In most published cases, the ingested dose was much lower and was responsible for less severe clinical effects (4): generalized seizures easily controlled by benzodiazepines (5-7), sinus tachycardia (5,(8)(9)(10), conduction disorders with widening of the QRS complex (11), and prolongation of the QT interval (12)(13)(14). These effects return to baseline within several hours (5,10,15). Peak plasma values are reached within three hours of ingestion, the mean elimination half-life is 21 hours, and bupropion is extensively metabolised by multiple pathways, with no single pathway predominating (16).…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic shock and status epilepticus after massive bupropion overdose

Morazin

Lumbroso

Harry

et al. 2007

Clinical Toxicology

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Background. To describe a profound cardiac dysfunction and a status epilepticus after a massive bupropion overdose. Case report. A 35-year-old man was admitted in coma following the deliberate ingestion of 12 g of bupropion. The course was marked by the rapid onset of severe and prolonged status epilepticus and cardiogenic shock. Plasma bupropion level determined four hours after the estimated time of ingestion was 1.4 mg/L. All clinical features resolved completely in response to symptomatic treatment. Conclusion. Several cases of bupropion overdose, with sinus tachycardia and seizures rapidly corrected by symptomatic treatment, have been reported in the literature. To our knowledge, this case of overdose with bupropion alone, at very high doses, is the first to describe clinical features comprising severe and prolonged status epilepticus and direct cardiotoxicity with the development of cardiogenic shock documented by echocardiogram.

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“…Overdose with ziprasidone and bupropion in a 17-year-old male adolescent with psychotic depression led to an ED evaluation. 53 One hour after ingesting 120 20-mg tablets of ziprasidone; between 15 and 20 tablets of bupropion sustained release, 150 mg; 15 tablets of clonazepam, 0.5 mg; and 4 tablets of lorazepam, 0.5 mg, the patient was drowsy but responsive to verbal commands. Subsequently, he became stuporous and underwent elective intubation.…”

mentioning

confidence: 99%

“…Four hours after overdose, an ECG showed a QRS complex of 100 ms and a QTc interval of 600 ms. No torsades de pointes developed. Based, in part, on the case by Shrier et al, 59 Biswas et al 53 pointed out the cardiotoxicity of the combination of ziprasidone and bupropion in overdose. The authors stated that this overdose combination may require several days of careful cardiac monitoring and meticulous management.…”

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confidence: 99%

New Generation Antipsychotic Drugs and QTc Interval Prolongation

Vieweg

2003

Prim. Care Companion CNS Disord.

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Background: Recent regulatory and clinical concerns have brought into sharp focus antipsychotic drug-induced QTc interval prolongation, torsades de pointes, and sudden cardiac death. Several new generation (atypical) antipsychotic drugs have either been withdrawn from clinical use or delayed in reaching the marketplace due to these concerns. Because torsades de pointes is rarely found, QTc interval prolongation serves as a surrogate marker for this potentially life-threatening arrhythmia. Current methods of calculating this electrocardiographic parameter have limitations. The primary care physician is a key member of the team managing a patient who requires administration of antipsychotic drugs. This article focuses on new generation antipsychotic drugs and principles useful to both the primary care physician and the psychiatrist.Method: PubMed was searched in September 2002 using the terms antipsychotic drug and QT interval. References were examined from review articles describing antipsychotic drugs and the QT interval. The author's files gathered over the past 20 years on the QT interval were also reviewed.Results: Nine cases were available in which druginduced QTc interval prolongation was associated with new generation antipsychotic drug administration. Eight cases were taken from the literature, and the author added one additional report. The newer agents involved were risperidone, quetiapine, and ziprasidone. In at least 8 cases, there was evidence of other risk factors associated with QTc interval prolongation. In one case frequently referenced in the literature, the authors misunderstood their own data showing that QTc interval prolongation did not relate to delayed ventricular repolarization. In another instance, 2 authors reported on the same patient, with important information missing from both articles. No evidence of torsades de pointes appeared in any of the 9 cases.Conclusions: No evidence is currently available in the literature implicating new generation antipsychotic drugs in the production of torsades de pointes. However, the absence of such evidence does not prove that newer antipsychotic drugs do not cause torsades de pointes. Among patients free of risk factors for QTc interval prolongation and torsades de pointes, current literature does not dictate any specific consultative or laboratory intervention before administering new generation antipsychotic drugs. When risk factors are present, evaluation and intervention specific to those risk factors should dictate the clinician's course of action. More specific guidelines for monitoring the QT interval and risk of torsades de pointes await improved methods of measuring the QTc interval relevant to each patient.(Primary Care Companion J Clin Psychiatry 2003;5:205-215)

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Cardiotoxicity Associated With Intentional Ziprasidone And Bupropion Overdose

Abstract: We present a case that underscores the potential cardiotoxicities of these medications. Ziprasidone and bupropion ingestion can be associated with cardiotoxicities that may require several days of aggressive cardiac monitoring and treatment.

Cited by 22 publications

References 12 publications

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Cardiogenic shock and status epilepticus after massive bupropion overdose

New Generation Antipsychotic Drugs and QTc Interval Prolongation

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